Bureau of Health Care Financing Administration

Håfa Adai, Welcome to the Bureau of Health Care Financing Administration webpage! We serve to administer the Medicaid and Medically Indigent health care programs for our Guam residents to improve and sustain their quality of life and to ensure that health care is available and accessible for both on-island or off-island services. We hope you find the information you need and welcome your feedback to better improve our webpage.

Mission

The mission of BHFCA is to administer local and federal health care programs to assist low-income individuals and families who are uninsured or have adequate insurance coverage and ensuring that the quality of health care is available and accessible for both on-island and off-island.

Our Goals

  • To ensure that quality health care is available and accessible for Medicaid/MIP recipients seeking health care for either on-island or off-island services.
  • To process on a timely basis claims submitted by health care providers for services rendered to Medicaid/MIP recipients.
  • To continue to seek and implement methods of cost containment to the Medicaid/MIP Programs.
  • To Plan, organize, coordinate, and implement changes to Medicaid/MIP operations, policies and claims processing system in order to comply with Health Insurance Portability and Accountability Act (HIPPA) in order to avoid federal sanctions.
  • To administer the Enhance Allotment Plan to dual Medicare eligible for prescription drugs.
  • To keep up with the timely submission of local and federally mandated reports requested on a quarterly and annual basis
  • To establish the Medicaid Integrity Program within the Bureau of Health Care Financing Administration.
  • Inside the Bureau of Health Care Financing Administration

    Program Management Section

    The Program Management section is responsible for the financial and program management support; development, monitoring & evaluation of the program state plan, policies and procedures, operations, manuals, and rules and regulations.

    Operations Section (Claims Processing)

    The operations section oversees the utilization control, claims processing unit, EPSDT/Medicare buy-In, off-Island referral coordination and claims intake/file.

    Quality Management Section (Benefit Coordination)

    The Quality Management section is responsible for maintaining and developing the quality management of the Operation & Program Management Section and benefit coordination for prior authorization and medicaid fraud and control unit.

    Contact Us

    DPHSS Bureau of Health Care Financing Administration ITC Building Ste 219 590 S Marine Corps Dr Tamuning, Guam 96913-3532

    Program Management Section: 

    Tel: (671) 735-7470/7471
    Fax: (671) 735-7476

    Operations Section:           

    Tel: (671) 735-7237
    EPSDT/Medicare Buy-In: (671)735-7474
    Off Island Referral: (671)735-7231
    Claims Intake/File: (671) 735-4505

    Quality Management Section

    Tel:(671) 735-7470
    Fax: (671) 735-7476
    Prior Authorization: (671) 735-7473
    Medicaid Fraud and Control Unit: (671) 735-7243
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